Only days after HHS Secretary Mike Leavitt released the names of the 16 commissioners who will sit on the American Health Information Community, some healthcare industry executives described the appointees as being too far removed from the trenches to be effective.
Noticeably missing from the panel, they said, are representatives of the very people the AHIC intends to influence most -- the hands-on chief information officers and hospital managers who are charged with bridging computer infrastructures to track patient records and the critical data contained within, said Angela Haas, chief medical information officer at Susquehanna Health System in Williamsport, Pa.
"My real concern is that this committee truly doesn't have any practical experience," Haas said. "All of these people -- though I'm sure very intelligent and theoretically driven -- are not going to make it happen."
Haas' comments are in line with what other hospital managers said about the committee on and off the record. Andrew Gettinger, medical director for information systems and associate medical director at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., said that the AHIC seemingly was chosen more for the "high profile" of its members than for their hands-on experience. Peter Waegemann, chief executive at the Medical Records Institute, a for-profit group that has championed the use of electronic medical records for more than two decades, also came to the same conclusion and chided HHS for naming members who are "too politicized."
Also noticeably absent from the task force are representatives from other major healthcare organizations whose members have a stake in healthcare IT: the American Hospital Association, the American Medical Association, the Healthcare Information & Management Systems Society, the American Health Information Management Association, the Joint Commission on Accreditation of Healthcare Organizations and America's Health Insurance Plans.
But many of those organizations said that they expect to be included in one or more of the working groups that AHIC members plan to rely on to help shape IT policy and procedures.
"It will be very interesting to see how it works," Waegemann said. "It's a very political approach and not a practical one." He conceded that while the formation of the committee is a step in the right direction, "Whether or not it's the right approach, we don't know."
Leavitt announced the committee members on Sept. 13. He'll also chair the team, which consists of a mix of association and private industry executives, as well as representatives from federal agencies such as the CMS, the Centers for Disease Control and Prevention and the Defense Department.
What's clear, however, is that the AHIC team faces an uphill trudge in realizing President Bush's election-year promise to move hospitals to digital records within 10 years. The process at Susquehanna took roughly 18 months of planning before its EMR went live -- and that was for just one hospital, Haas said.
HHS is expected to spend $86.5 million on IT this fiscal year, and Bush has asked Congress for $125 million for IT spending in the fiscal 2006 budget (June 13, p. 6). But hospital executives said that the money earmarked for IT will largely fall short of what it would take to upgrade the systems at the nation's more than 5,000 hospitals and 200,000 physician offices.
Indeed, many hospital executives said that to make interoperable electronic medical records a reality, the AHIC will have to waive certain Stark rules and antikickback regulations, which prevent hospitals from extending certain services to stand-alone physician offices, Haas said.
For instance, even while Susquehanna is wired for EMRs -- and has been since 2000 -- physicians who also see Susquehanna patients may not be, Haas said. Under federal law, the medical center can't buy one of those physicians a computer that links to the mainframe "because it would be in violation of Stark," she said.
Nevertheless, members of the influential AHIC panel see their responsibility in a different light -- one that is heavy on policy, but also one that will lean on a number of work groups to help shape that policy.
Chip Kahn, president of the Federation of American Hospitals and an AHIC member, says that in his conversations with Leavitt, the HHS secretary made it clear that the team will be "very much a working group. He wants to proceed with the agenda of interoperability that is going to be developed as rapidly as possible."
The AHIC plans to lean on the working groups for the practical components to realize the committee's goals. "I think that part of the task of this group is going to be to separate out broad concepts and policies that then have a whole lot of technical meat, which will then be filled in by tech people," he said. "This panel will deal largely with the political and economic issues."
"It's a very diverse group, representing a broad range of healthcare stakeholders, healthcare professionals and policymakers at the federal and state level," CMS Administrator Mark McClellan said. "The goal is to get to the president's vision of an interoperable, electronic healthcare system and to do it as quickly as possible."